A Heartfelt Thanks to Paramedics, Doctors for Coordinated Cardiac Care

11.19.07

ALLENTOWN, Pa.– Richard Silverman shouldn t be alive after the kind of massive heart attack he had at work last month.

But the 62-year-old South Whitehall Township man stood at a news conference at Lehigh Valley Hospital-Cedar Crest last week in testament to efforts that brought him life-saving, artery-opening treatment in a record 24 minutes.

I m grateful to a lot of people in the room today, said Silverman, standing beside his wife, Jan, in an LVH procedure room filled with doctors, nurses and paramedics.

Dr. Richard MacKenzie, LVH s chairman of emergency medicine, said the 24 minutes it took staffers to open Silverman s blocked artery with a balloon-tipped catheter after he arrived at the emergency room door is almost unheard of in the country. It s about half the door-to-balloon time LVH averaged the past few months.

Almost all the Lehigh Valley s hospitals are equipped to perform the life-saving balloon angioplasty procedure. But only one-third of the U.S. hospitals specializing in heart care have met the national goal of 90 minutes or less set last year by the American Heart Association and American College of Cardiology.

Two steps made the difference in Silverman s case, doctors said: His wife, who works with her husband at an Allentown dental lab, called 911 in spite of his protests; and paramedics performed an electrocardiogram, or EKG, on Silverman s heart before taking him to the hospital.

Because the patient did not drive himself to the hospital and doctors at the hospital did not have to repeat the EKG, vital time and heart muscle were saved.

Time is muscle, said Dr. Andrew Miller, an LVH emergency physician. The faster you can get a patient in to relieve a heart attack, the better the patient will do.

Training paramedics to interpret the EKG and share test results with doctors receiving their calls began at LVH this summer but is a new protocol in development regionally as well as nationally.

There is not just one hospital doing this, said Everitt Binns, executive director of the Eastern Pennsylvania Emergency Medical Services Council, which oversees advanced and basic ambulance service in Berks, Carbon, Lehigh, Northampton, Monroe and Schuylkill counties. Contacted after the news conference, Binns said the council is taking a regional approach to standardize the added training for paramedics and the added equipment purchases for all 37 advanced ambulance services in the region.

That puts the Valley well ahead of other regions in the state and nation, Binns said.

It was fitting that Silverman was one of the first to benefit from the training. His father, Dr. Morton Silverman, helped launch LVH s heart program in the mid-1960s. He is now 95 and lives in Bethlehem.

When paramedic Steph Burke of Cetronia Ambulance Corps took the extra step to save Silverman s life on Oct. 18, however, it was her first day on the job.

Burke didn t trust Silverman s claims that the burning in his chest was just acid reflux that would soon go away. His gray color and profuse sweating told her otherwise.

She attached 12 EKG leads to his chest instead of the usual four for a more definitive diagnosis. While en route, she described what she saw to emergency physicians answering the call.

Awaiting Silverman s arrival, the emergency room and cath lab staffers then moved the patient as quickly as possible from the emergency room to the cath lab, where heart specialist Dr. Nainesh Patel found a life-threatening blockage in a major blood-supplying artery, sometimes called the widow-maker. Patel used a balloon-tipped catheter to open the blockage and placed a brace-like metal stent inside to keep it open, restoring blood flow and oxygen to Silverman s heart.

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